May 5, 2014

Keep Moving Forward

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I feel I may be in danger of developing some sort of mental health disorder as a result of the rollercoaster that is ICD-10. I’m sure I’ve experienced every emotion possible, from elation to the depths of depression and sorrow. The latter was just a matter of days ago with the announcement that ICD-10 would be delayed yet again. And I’m quite sure I’m not the only one. But that raging optimist that lives within me keeps me focused on the finish line and the ultimate prize: quality healthcare data.

I’m not going to waste anyone’s time with the same talking points. By now, you’ve read them a thousand times in a hundred different ways. We know the ramifications of a delay for those of us who were well down the implementation path. And we know what a relief this is for those of us who were not on target to make the date. There are always two sides: a light and a dark. So I’d like to posit that we change our focus from the benefits and challenges associated with ICD-10 and instead look at what the barriers are to implementing ICD-10.

The first one that seems to be the most prevalent is the associated costs with implementing. An American Medical Association (AMA) study by Nachimson Advisors, LLC, estimates that the cost of implementation for a typical small practice is between $56,639 and $226,105. There is no doubt that these numbers have triggered much anxiety in those who were already struggling with implementing ICD-10, and it is much harder for a small, independent practice to absorb the costs of making the transition. It should be noted that much of the cost surrounds vendor systems and software upgrades, some of which are required for meaningful use and not just ICD-10. But since Meaningful Use is already underway and included an incentive, ICD-10 gets the blame and then the axe.

The second is the collective belief that ICD-10 does nothing to improve patient care. This is absolutely true. ICD-10 does not treat patients, so it is silly to think that it alone will improve patient care. What ICD-10 does do is shake things up. In order to implement ICD-10, we’ve had to look at our current documentation and coding processes, and maybe we aren’t as perfect as we thought we were. Or maybe, we realized that we document and code reflexively instead of natively. Whatever it is that we’ve uncovered, it begs the question, “Is this the best we can do?” I’m betting that it isn’t. Dr. Joe Nichols, a board Certified Orthopedic Surgeon, fellow AHIMA Approved ICD-10 Trainer, colleague, and mentor contends that the new concepts in ICD-10 are concepts that a physician should already be documenting now. These concepts play an important role in understanding risk and severity as well as comorbidities and causation of conditions. These are elements of proper healthcare assessment and treatment.

The definition related to fractures through the growth plate in children is very limited in ICD-9. ICD-10, however, includes codes that define growth plate fractures based on the Salter-Harris I-IV classification.

This is a long-standing and widely used classification that identifies significant differences in risk of deformity and need for surgical treatment related to these growth plate fractures.” – Joe Nichols, MD, Applications and Technologies Collaborative ICD-10 Physician Impacts (March 2011), The Advisory Board Company

In short, ICD-10 is not requiring anything new of us, but simply to return to our roots in terms of documentation and then offering a code that correlates to those concepts. It is helping us improve patient care by requiring that we communicate these concepts in the medical record using documentation and then applying the appropriate code that will be used post-claim adjudication for myriad purposes. ICD-10 is not the enemy. But it is challenging us to change how we operate and communicate in healthcare in the 21st century.

The third, and final, barrier has little to do with ICD-10 but can be neatly disguised as whatever specific challenge is facing us: Change.

I’ve said all along that this implementation is less about ICD-10 and more about change and those of us who resist it. There are many people who see that the world of health information is fine just the way it is. It works just fine, so why change? But if we don’t make the change and start collecting more detail and using data in a more proactive way, then how do we really know what we’re doing right now is working? The answer is that we don’t really know. What we know is that every day we go to work, see our patients, submit our claims, get paid, process claims, pay claims, etc., and nothing breaks. That doesn’t necessarily mean that we’re doing the best we can. That just means we’ve refined the status quo into a predictable process. Change is scary and it has a habit of challenging our beliefs. What if we’re resistant to the point of being detrimental to ourselves as users of the healthcare system? In the end, we are all users of the system we’re helping to create. Doesn’t it make sense to make changes to the system so that we can all reap the rewards of a better system?

I’m not saying that ICD-10 is the cure to all of our healthcare ills. In fact, for me, it may very well be the cause of some sort of new condition. But what ICD-10 does do is challenge our status quo and invites us to make the changes our healthcare system desperately needs to be the absolute best it can be. So please, keep moving forward. Don’t falter in your momentum, and use this opportunity to make the implementation of ICD-10 something of which we can be proud.

About the Author

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial payer and Medicare and Medicaid. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.

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Mandy Willis, CCS, CPEHR

Mandy Willis is a Certified Coding Specialist and AHIMA Approved ICD-10 Trainer with 15 years of experience in the healthcare industry. She has worked in the small physician practice environment, commercial and public payers. She is also co-chair of the Workgroup for Electronic Data Interchange (WEDI) ICD-10 Coding and Translation Subworkgroup. Currently, her focus is on assisting all sectors of the healthcare industry in making the transition to ICD-10.